Provider Demographics
NPI:1265700702
Name:JORDAN, ANN THERESE (OTR/L)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:THERESE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 COUNTRY GROVE LN
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-1905
Mailing Address - Country:US
Mailing Address - Phone:760-943-6801
Mailing Address - Fax:760-943-6801
Practice Address - Street 1:533 2ND ST
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3558
Practice Address - Country:US
Practice Address - Phone:760-814-4938
Practice Address - Fax:888-773-3272
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 1430225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology